Overview
Designated service provider (DSP)
When you use the services of a Designated Service Provider (DSP), all claims, including Prescribed Minimum Benefits, are paid in full. This means you will not have to make out-of-pocket payments when using the services of these providers.
These Designated Service Providers are specific providers of healthcare services, for example General Practitioners and Specialists, who have agreed to provide services to the LA Health members according to certain agreed rules. The Scheme pays these providers directly.
In certain instances you must use the services of the designated service providers. If you do not use these services you may have to pay deductibles or make co-payments.
In certain instance you will not have to pay co-payments or deductibles
The Scheme will still pay the Prescribed Minimum Benefit claims in full if you have involuntarily obtained the services from a provider other than a designated service provider, if:
- it was an emergency, for hospital admissions
- the service was not available from the designated service provider or would not have been provided without unreasonable delay; or
- there was no designated service provider within a reasonable distance from your place of business or residence.
The Scheme’s designated service providers for the diagnosis, treatment and care costs (which may include medicine) for Prescribed Minimum Benefit (PMB) conditions are:
| Specialist Services | The Premier Specialist Network |
| General Practitioners’ Services | The Discovery GP Network |
| Chronic Medicine | Any pharmacy willing to charge dispensing fees at the Scheme’s Medicine Rate. |
| Drug and alcohol rehabilitation | SANCA or RAMOT |
| Renal care, including dialysis | National Renal Care |
It is likely that the Scheme will contract with, and appoint more designated service providers, particularly provider networks, in its ongoing efforts to control and reduce costs for members.
Where the Scheme has appointed a Designated Service Provider (such as these listed above), non-emergency PMBs will only be paid in full if the services are obtained at the DSP.